From the Guidelines
Ventricular tachycardia is considered to occur at a rate of greater than 150 bpm, particularly for monomorphic VT, as stated in the acc/aha guidelines 1. When evaluating ventricular tachycardia, it's crucial to consider the patient's hemodynamic stability and the specific characteristics of the arrhythmia.
- Key factors in determining the severity and management of ventricular tachycardia include:
- The presence of hemodynamic compromise
- The morphology of the ventricular tachycardia (monomorphic vs. polymorphic)
- The rate of the ventricular tachycardia According to the guidelines 1, for monomorphic VT with rates greater than 150 bpm, treatment with a 100-J synchronized discharge is usually indicated, whereas immediate cardioversion is generally not needed for rates under 150 bpm.
- Management strategies for ventricular tachycardia may include:
- Urgent electrical conversion for hemodynamically compromising VT
- Medications such as lidocaine or procainamide for brief trials in hemodynamically stable patients
- Amiodarone as an alternative treatment option It's essential to prioritize the patient's hemodynamic stability and adjust the treatment approach accordingly, as indicated in the acc/aha guidelines 1.
From the Research
Definition of Ventricular Tachycardia
Ventricular tachycardia (VT) is a type of irregular heartbeat that originates in the ventricles, which are the lower chambers of the heart. The rate at which VT is considered to occur is typically defined as:
- A heart rate of more than 100 beats per minute (bpm) 2, 3, 4, 5, 6
- Three or more consecutive premature ventricular contractions (PVCs) in a row 3, 4
Diagnosis and Treatment of Ventricular Tachycardia
VT can be diagnosed using various methods, including:
- Electrocardiogram (ECG) 2, 3, 4, 5, 6
- Holter monitoring 3, 4 Treatment for VT typically involves the use of antiarrhythmic medications, such as:
- Amiodarone 2, 3, 4, 5, 6
- Lidocaine 2, 4, 5 In some cases, other treatments may be necessary, such as:
- Cardioversion 3, 4
- Defibrillation 2, 4, 5
- Implantable cardioverter-defibrillator (ICD) therapy 6
Key Findings
Some key findings related to VT include:
- Amiodarone is commonly used to treat VT, but its efficacy has not been empirically examined in the prehospital setting 3
- Lidocaine may be associated with higher rates of return of spontaneous circulation (ROSC), 24-hour survival, survival to hospital discharge, and favorable neurologic outcome compared to amiodarone 5
- The optimal treatment for VT depends on various factors, including the patient's underlying medical condition, the severity of the arrhythmia, and the availability of medical resources 2, 3, 4, 5, 6